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CMS postpones some Medicare Part D changes

March 11, 2014
by Lois A. Bowers, Senior Editor
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The Centers for Medicare & Medicaid Services (CMS) has announced plans to postpone implementation of several changes to the Medicare Advantage (Part C) and Part D prescription drug program it had proposed in January, citing “complexities” of related issues and the feedback it had received by the March 7 deadline. Administrator Marilyn Tavenner says the department plans to seek additional input before implementing some or all of those changes in the future.

“During the rule’s comment period, we received numerous concerns about some elements of the proposal from members of Congress and stakeholders,” Tavenner wrote in a letter to several members of the House of Representatives. “In particular, we heard concerns about the proposals to lift the protected class definition on three drug classes, to set standards on Medicare Part D plans’ requirements to participate in preferred pharmacy networks, to reduce the number of Part D plans to sponsor may offer, and clarifications to the non-interference provisions.”

Although those changes are on hold, CMS does plan to finalize proposals that would enable seniors to access care during natural disasters, would strengthen standards for prescribers of prescription drugs and would broaden the release of privacy-protected Part D data, Tavenner said.

In a posting online, LeadingAge Senior Vice President of Public Policy and Advocacy Cheryl Phillips, MD, noted that “many LeadingAge providers were concerned about lifting the protective class definition on three drug classes, including antidepressants and antipsychotics.”

The American Health Care Association and the National Center for Assisted Living had expressed concerns with the proposed Part D rule, too. “CMS’ proposed Part D approach is a relatively blunt strategy and more effective strategies are available that would not limit access to medications and can help assure more appropriate use of medication and less expensive medication when overall equivalency is found in the literature,” the organizations told CMS before some proposals were put on hold.

The National Community Pharmacists Association, however, said it was “deeply disappointed” that CMS was not moving forward with the pharmacy choice provision in the proposed rule, describing preferred pharmacy drug plans as inadequate, deceptive and confusing to seniors.

"We encourage CMS to move forward with other key provisions in the rule, including expanding medication therapy management…eligibility; giving more seniors the same co-pay, in certain instances, whether they use a community pharmacy or mail order; allowing CMS to require plan sponsors to hire independent auditors; banning reimbursement practices that penalize long-term care pharmacies for adopting cost-efficient dispensing practices; and protecting seniors by establishing fulfillment requirements for mail order pharmacies, in response to a litany of complaints,” the organization said in a press release.